Inside the Hidden Crisis of Unsafe Hospital Discharges, and the Patients Forced to Face Trauma and Homelessness Alone
The woman wasn’t discharged so much as shuffled through a system that had nowhere to put her. A survivor of human trafficking in her late 30s, she had finished a short hospital stay but needed long-term mental-health treatment.
The hospital social worker told Hannah Laflin, a licensed alcohol and drug counselor with a master’s in health care administration, that there were no appropriate placements available.
“I don’t feel comfortable dropping her off at a homeless shelter,” the social worker said. “I just don’t know where else to put her.”
The woman was eventually discharged anyway — to a program unequipped to provide the specialized trauma care she needed. For Laflin, who has worked for eight years on the front lines of mental health treatment in Massachusetts, this wasn’t an exception. It was routine.
“It’s happening every day — patients are discharged without proper support because there simply aren’t enough appropriate placements available.”
A Familiar Pattern
Laflin specializes in complex trauma, substance use, and human trafficking cases. She doesn’t work in a hospital but receives patients who are discharged from them — often with little to no information about their medical or psychiatric needs.
“Sometimes patients arrive at a facility with only a brief clinical summary,” Laflin explained. “For those experiencing complex trauma or active psychosis, that’s not nearly enough information to ensure safe and effective care planning.”
She described one recent case in which a young woman was referred for outpatient counseling — but upon arrival, it was clear she required inpatient psychiatric care. “She didn’t belong in that level of care. But she was in my program now. I had to find her placement immediately. That happens a lot.”
Laflin said these mismatches are driven by structural shortages, not individual negligence.
“Hospitals are overloaded. They’re not dumping patients because they want to — they have no choice.”
She added that hospital social workers are often forced into triage, making fast decisions with limited options.
Her description echoes what advocates and clinicians have reported on the West Coast, including patient dumping at Los Angeles General Hospital, where people experiencing homelessness were discharged into dangerous conditions with little follow-up.
A System Without Beds
Nationally, hospitals face an acute shortage of psychiatric beds. A 2025 national analysis of Centers for Medicare & Medicaid Services–certified hospitals found just 28.4 inpatient psychiatric beds per 100,000 people, far below the 60 beds per 100,000 experts consider minimally adequate. When no placement exists, patients are often discharged to programs that aren’t appropriate — or, in the worst cases, to the streets or shelters.
Under the federal Emergency Medical Treatment and Labor Act (EMTALA), hospitals must provide emergency care and ensure safe discharges, regardless of a patient’s ability to pay. But in practice, enforcement is uneven, and cases like the one Laflin described rarely make headlines.
“It’s not that anyone’s proud of it,” she said. “Nobody wants to admit they dumped a patient. But it happens quietly. Every day.”
This reality mirrors other systems where hospitals and local governments prioritize clearance over care — such as California encampment removals and hospital discharge policy, where forced sweeps often push people into cycles of hospital visits and unsafe discharges.
The Bottleneck Before the Streets
The problem begins before discharge. A 2024 study mapping how discharge processes for unhoused patients often break down found minimal follow-up planning, gaps in coordination, and little accountability once a patient leaves the hospital doors. Those gaps are visible in Massachusetts — and they echo patterns reported in Los Angeles and other cities nationwide.
“We have incredible hospitals, but there’s a critical gap in step-down care for people who need something between acute inpatient and independent support,” Laflin said. “For patients that have state insurance, there just aren’t many options.”
This gap is compounded by insurance disparities: patients with private insurance can more easily find an appropriate facility, while those relying on state insurance, like MassHealth, face far fewer options.
“There just aren’t enough state-funded beds,” she said. “And if someone comes from out of state, it’s even harder.”
Researchers say the result is predictable: discharge to unstable or unsafe settings. It’s the same dynamic behind broader health care inequities in Skid Row and elsewhere in the country.
Staff at Breaking Point
Laflin’s caseload can run up to 50 to 60 clients a week, many of whom have survived human trafficking or severe violence. Hospital social workers face similar pressures.
“They’re doing 12-hour shifts,” she said. “They see patient after patient. They have to make fast decisions. And that’s not how complex trauma should be handled.”
She said the burnout is staggering, but it’s also a structural issue.
“This isn’t about blaming nurses or social workers. It’s about the system being set up to fail the people who need it most.”
What Could Work
A recent analysis by the Center for Health Care Strategies found that discharging patients to medical respite programs in Massachusetts reduced hospital readmissions by 51%. These programs provide short-term housing and medical oversight — bridging the gap between hospital and permanent housing.
Advocates say expanding medical respite beds, improving discharge planning, and increasing coordination between hospitals and community providers could help curb unsafe discharges.
“More staffing, better training, improved access to services, and truly individualized care — that’s what we need,” Laflin said.
Other experts have argued for stronger enforcement of EMTALA and better oversight of emergency room discharges and homelessness policy coverage.
A Local Crisis, National Pattern
Although Laflin’s work is based in Massachusetts, she insists the issue isn’t unique to one state.
“It doesn’t discriminate between public or private hospitals. It’s a nationwide problem,” she said. “We just don’t have enough services.”
Her trafficking survivor patient is still waiting for an appropriate placement. She’s one of countless patients shuttled through a system designed more for throughput than for recovery.
“It’s heartbreaking,” Laflin said. “You do everything you can. But the system doesn’t give you enough to work with.”